Rest, Baccarat. Rest, Good Dog

The empty bench

You have to imagine Sam and I sitting here, eating our tortilla wraps (and he his roast beef sandwich on industrial baguette) the other evening. He came after work, taking the RER from Nanterre to the Gare de Lyon, and another to Alfortville, after a long day at work. Dr. Gouni waited for us. She said she had work to do, anyway, but she's like my husband. I know what that means. She thought it was important for Sam to see Baccarat again before the surgery because we cannot know how it will turn out.

Earlier, I told Baccarat that Sam was coming to see her, "Sam! Ton Sam va venir!", and her eyebrows jumped up her forehead, her tail starting to brush the flooring in cardiology with all the enthusiasm her heart can manage. Everyone laughed. She knew exactly what I was talking about. I know you are thinking, "It was the tone of voice she heard, not what you said."

No, you are not thinking that. You know, just like I do, that they understand that much.

It was like the day when my husband came to see her, arriving after Sam and I had. It was the first morning of her hospitalization at our veterinary clinic, and she was collapsed on the floor after a very brief walk, but when she saw him walk around the standing display of flea products and dog pheromones, "for a happy dog", her head shot up and her tail started cleaning that darker gray flooring.

"C'était seulement qu'elle pensait que j'allais la ramener à la maison, puisque vous ne l'avez pas fait," he joked. He knew that she was just happy to see him, too.

It was just past 7 pm when I went to pick him up on his way up the Avenue Générale de Gaulle on my motorcycle. He had walked enough for the day, and Dr. Gouni was already so kind to wait. She took us up to Baccarat's cage and left us with her.

We were tired and hungry, our heads aching, by the time we thanked Dr. Gouni for letting him come as late as he had to to be able to see her and emerged on the sidewalk.

"There's the Casino over there," I looked up the avenue, past the post office and towards the traffic circle, beyond which the A4 leads to the Péripherique and the A13 home. "We could get something to tide us over until dinner, maybe some sandwiches, and I need some things for dinner. Oh. There's not much room in the top case. I forgot."

"I have my backpack, Mom. We can put some stuff in there," he offered, still standing there on the same spot on the sidewalk. We weren't deciding anything very fast. The sidewalk is where we decompress.

"What do you say? Should we go get something, or just head home? My head is killing me." I had barely eaten anything since my scrambled eggs long ago that day.

"Alright."

"Okay, then, let's go." We stood there another second. He had joined me in my state of suspension.

We got sandwiches from the display at the entrance to the store, looked at the soda. Found a sandwich the color of the salami of which was too gray to be considered consumable and gave it to the guy at the "welcome" desk.

"I know just how he feels," said Sam, "when someone finds a sandwich that's gone off, someone's going to make a complaint. You try to get them before anyone else does." His job this summer has been refilling vending machines for his uncle at one of their biggest clients in Suresnes. He knows about sandwiches and standards of freshness, margins of profit on soda and coffee. "There's a Coke Lite left, Mom," he added.

He stuck his hand in the water vapor over the fresh vegetables.

"What's that?"

"Water to keep them fresh." We looked for the string beans, if there were any, and picked up some organic bananas. "I'd better get a small bunch, for the backpack, but you'll eat one, maybe?"

"Yeah. I'll eat a banana," he said. We still hadn't found any green beans and made another trip around the vegetables.

"My hand doesn't get wet when I put it in the gas," said Sam.

"It's not a gas; it's a vapor," I replied.

"Vapor is a gas, Mom," he said. He was right. We wandered off, looking at the meat, looking for jambon de pays for the melon I had picked up and put back down, thinking of space. I remembered and left the jambon de pays. We walked through cheeses, and Sam picked up a package of prewrapped cheese slices for Croque Monsieur sandwiches.

"Now this is what I am going to need," said Sam, with a new energy we had been lacking.

"But, I buy those already. Usually the cheddar ones for your cheeseburgers," I said. I thought he had seen these a million times, in our fridge, but certainly at my husband's parents' home, where it is staple to feed the army of grandchildren a light supper.

"Oh. It's just the cheese," said Sam, disappointed. "I thought it was the sandwiches."

"Sam, it's really easy to make the sandwiches from the cheese slices."

"I am going to buy lots of pre-made sandwiches, all ready to heat."

"You're going to need much more than that, if you are going to survive law school." He looked back toward the soda and headed off, returning to tell me the last Coke Lite was gone and he had decided against a Coke for himself. He seemed disappointed for me. I rarely drink Coke Lite. It was considerate of him, anyway. "Where are the smoothies," he asked. "I am in one of my healthful foods phases," he added. "The other day, in the Marais, I got an oxygen water. Twice the oxygen of normal water."

"They're right here." I pointed to the juices, just next to where we happened to be standing, still looking toward the display of Coke and Coke Zero, back across the tables of fruits and vegetables, appearing fresh under their streams of gas.

"I want mango and passion fruit."

He compared the Tropicana and the Innocent ones and found the Innocent less expensive. It looked like more, but it was the same size as the Tropicana. A lesson in packaging, but he already knew that. He knows how to look for the price by weight or volume, and read a label.

We headed past frozen foods, and along to the end of the store, scanning the shelves. I didn't know what I wanted. I couldn't concentrate. He was patient, or the same as I was. We had cheese, bananas, dates, sandwiches, fruit smoothie. We negotiated the self-check and headed to sit on the bench, eat our sandwiches and watch the students and residents leave the school and the hospital to enjoy the regular lives on a warm July evening. I watched the vet in her last year of residency who took care of Baccarat last week cross the street, thinking their lives go on; it's normal.

Yesterday, Baccarat and I lay on the ground under a chestnut tree on her last afternoon before surgery. It was cool, and there was wind. It would rain later. I gazed up at the undersides of the chestnut leaves and watched the students walk the dogs who could run and chase sticks. Baccarat watched, too. She knows she can't.

They had found the mass in her heart quite changed, and they were inside meeting about her case, while we rested together outdoors, I on my back on my big cotton scarf, the one I bought in Petit Andelys last summer. The mass had gotten smaller, from a peek of 7 cm in one direction, to 5 cm, and it had moved further into the ventricle from the atrium. Some dark spots in the area where it was thought to be connected to the heart wall had appeared.

"Ce sont des petits endroits de liquide, comme dans son abdomen," said Dr. Gouni. "C'est normal qu'on les trouve là si elle a de la liquide dans le ventre. Mais, on voit que ce n'est attaché que par des filaments, ce que donne l'impression de quelque chose moins tumorale, et plus de thrombose." There were little areas of liquid visible where the mass attached to the heart wall, which is normal, since there is liquid in her belly, and it appeared now that the mass was attached by filaments, and not to a tumor. This, she said, does give the impression that it is a clot, and less a tumor.

"Mais les filaments peuvent être cancereux," I asked. She nodded. They could be cancerous, too.

It was also much darker in appearance, indicating that her body was doing what it is supposed to and working to degrade the clot part by lysis, which confirms it's appearing to be smaller. New clot formation shows as white areas, and when Dr. Gouni showed me the images later, I could see that it was no longer white, only white in small areas.

She pointed to the valve in the right heart, visibly opening and closing with the beats of her heart, but there was no valve visible on the left side. The mass is keeping it open, all the time. She thought she could see a bit of it, and I could see a white bit, similar to those of the valve on the right, held close to the wall of the left heart. She explained that this can damage the valve, and that they have a valve ready for Baccarat, in order to replace hers if it is determined necessary.

"On préfère ne pas le faire," she told me, "si on peut l'éviter. C'est déjà une intevention très --"

"Lourde," I finished, trying to be helpful. She nodded.

"Oui, très lourde. Si on peut éviter de faire plus, on l'évitera pour elle, mais je pense que la valve doit être bien abîmée."

"On peut avoir l'impression d'être chez le garagiste, avec le remplacement des valves," I joked, weakly. She smiled and explained that the valves are given to the research center by the laboratories. They use them to do research. This valve had been given to them; it is worth 6,000 euros, but we would not pay for it, and it was, she explained to me, already prepared for another dog, who was to have been operated on at the beginning of the month. The owner never showed, and never called. They could not reach her. She and her dog disappeared.

"Le chien," she told me, "fut un Labrador." I already knew that.

But, Baccarat will never need that valve. The phone rang some minutes ago, too early. Too early for good news. Baccarat had a hemangiosarcoma, possibly a rhabdomysarcoma (embryonal) and it was bad. They had removed the tumor, and they could wake her, but it would come back, maybe as soon as in only two weeks.

I understood. It was time to make the decision. I knew what my husband thought, and I knew in my heart that he was right. Even if a dog's threshold of pain is much higher than ours, we would put her through recovery only to see another tumor replace this one in less than a month, only to have to let her die later, when she could go now, knowing nothing more than what she has been through already, after our afternoon yesterday, when I had told myself to live each minute, see the colors, feel the warmth of her body against my legs, the weight of her head on my arm, watch her eyes and her expressions to never forget them.

I handed him the phone.

She is gone now. We will pick her up later. They asked if they could keep her heart. It doesn't happen often that 4-year-old dogs are diagnosed with hemangiosarcomas or rhabdomyosarcomas, much less that they are operated on. Her heart will give them information, and perhaps her case will one day help another dog, another family. Perhaps the University of Colorado and the University of Pennsylvania's veterinary clinical studies will yield hope for preventing or curing hemangiosarcoma before anyone else has to watch their beloved animal go so quickly.

We will take her ashes to la Moraine, and leave them under the peaks of l'Aiguille Verte and Les Grandes Jorasses, where we walk under the boughs of the giant firs and feel the sky like a ceiling just above our heads. I am tempted to lie down on the earth there, as though it has a special power to bring peace and safety. It was her favorite place to run and play, in the snow, pushing her head and cheek into it like a snowplow, rolling, running, jumping in the deeper snow until I thought her heart would burst. Let her lay down there to become part of the mountain, the firs.

The mountains offer another form of peace, the rest of eternity. While I walk through the forest at their feet and feel the urge to lie down on that cold earth that beckons kindly, watched over and protected by the eternal peeks and soaring trees, promising to cradle me gently under the night sky, others climb the rock faces and the glaciers and find their rest and safety below the cold ground and snow.
-- "Rest", The Sisyphus Journals, February 24, 2009,

She will always be there, waiting for us, Sam and I.
....

The other patient

The koi in its Nifurpirinol bath, Day 13

It could really use a name now, couldn't it? I am nearly certain it's a female, but not enough to commit to a name. Maybe I should call it George, as in George Eliot.

No. That stinks. I'll just refer to it has "he" and "him" until I have a better idea.

I need to put together a series of photos, from the first day I put him in quarantine and began salt and anti-bacterial/antibiotic treatments to the present, to see if he really has improved as we think he has. His eyes seem to be less protuberant, and there is a less marked difference between the scales of his body from those of his tail, which is also to say that the scales of his tale now seem to stick out a little, too, but the rest perhaps less.

I pour over pictures of different varieties of koi, looking to see if his scales appear normal now by some variety standards, and one very encouraging thing is that the enlarged blood vessels around his right eye that appeared just after I began treatment disappeared within a couple of days of treatment, and they have not returned. Another is that he appears no worse, if not necessarily certainly all better. He is lonely in his quarantine tub, but that is better than dead. Sometimes he comes out when I come to visit him. He also seems to accept my removing him when it is time to change his water, to which I add a Nifurpirinol tablet, in addition to the salt, to his water, and I am no longer doing the concentrated, brief Nifurpirinol baths.

I am not sure he is eating anything, but that's probably just as well for his system, and besides, hiding all day behind his rock and plants doesn't require a large amount of calories. If he continues to do as well, I will return him to the "bassin" in a week or two and see how it goes, but don't say anything to him; I haven't told him yet, and I don't want to get his hopes up.

It's time to leave to go see Baccarat for the afternoon. It's her last afternoon before open heart surgery, and I am doing things I don't recognize that I am to stay calm. I don't know what you call it, but it's a lot like that afternoon when I knew Audouin would come home with the lab results for my melanoma. I remember thinking, up on my ladder painting the Orange Room, "Soon, you could get news that will change your life forever. You could learn that you won't live much longer," and I looked out the window at the sunshine in the flowers, the dogs and Shadow sleeping on the lawn, and myself spoke to me, Just enjoy this afternoon, this moment. It's what you have, and I felt peaceful, happy.

Sometimes, that's enough.

This evening, Sam will call me when he finishes work, and we will meet up on the Champs-Elysées to go see Toy Story 3. Like he was just the right age for Harry Potter when it came, and made a reader of him, he was the right age for Toy Story, so that 11 years later, when Andy is going to college and leaving his childhood room, so is Sam. We'll spend time together and enjoy that, and tomorrow will bring what it will. Each moment until they have the result of the biopsy is a moment of the present, when Baccarat is still alive and there is hope.

Everyone knows that it is already almost a miracle that she is still alive with this mass taking up nearly all the space inside her right heart, reducing the blood flow to a trickle, her circulation to a a stream in the desert. Her heart could fail at any moment, her brain be destroyed, but say the name of one of her beloved people, and the head darts up, the tail starts.

"Baccarat! Guess who's coming to see you! Sam! Sam's coming to see you!" and the tail is going. Everyone laughs because I could tell her in the same tone of voice that we were going to force feed her some more of that protein-rich food, and she'd stare out past the legs of the chairs and people and sigh heavily. She is still there.

"C'est un bon signe," they tell me, "qu'elle se bat. Elle aurait pu se laisser aller, mais elle reste avec nous et elle s'intéresse; elle se bat." It's true. She could let herself go; she could let herself die, but she is interested in what is happening around her, and she is hanging on.

"L'hôpital va lui manquer," I laughed, "Parce qu'ici, l'où elle va, elle est accompagnée par tous ses amis, un petit groupe d'étudiants, d'internes et de résidents! C'est très agréable!"

And, this is true, too. She will miss the hospital and all her friends there because wherever she goes, she is accompanied by a small troupe of friends, students, interns and residents. It is very nice to be so cared for.

Tomorrow, the car will take her and two vets, including Dr. Gouni, to Montsouris. At noon, the perfusionist will attach her to the cardiopulmonary pump, and they will begin open heart surgery. She is one of the very few dogs ever to undergo this surgery, which would be out of the question in the United States. Even here, where the surgeons are donating their time in the interest of trying to save her and to learn more, it is going to cost more than my son's lycée, as much as one year of his school in Paris during collège.

"There is no price that can be put on her life, Mom," he tells me again and again.

"There is, Sam. For everyone, there is a limit, a moment when they cannot spend any more. They just can't. For us, we are willing to make this sacrifice because she is so young, and because we love her, you love her so much, but for others, for most people, it would be out of the question." It is hard for him to accept this.

"Il faut être un peu psychologue dans notre travail," said Dr. Gouni yesterday, as I filled out the papers and wrote a check to IMM Recherche. My fingers spelled the sum out easily. I didn't need to make a list of all the things I could live without to make it possible. Like my friend said, we can eat potatoes for a couple months. "La plupart des gens ne pourrait pas se permettre de payer une chirurgie et les soins. On le sait et on leur n'en parle pas." One must, she said, be a bit of a psychologist in our work because most people could not pay for this surgery and the medical bills. We know it, she said, and we don't even suggest it to them.

"Je pense au chien," I answered. "Il n'a que son amour à offrir à son maître. Il n'a pas d'argent pour payer quoique ce soit. Si son maître est en train de mourir d'un cancer, on ne lui demanderait jamais de payer ses soins, de lui sauver la vie, alors, pour lui, c'est normal qu'on lui offre ce qu'on a, l'amour et de l'accompagner dans le temps qu'il lui reste. C'est bien à ses yeux.""

I think, I told her, of the dog. He has no money to pay for his master's medical bills were he dying of cancer. He only has his love to offer, and he will give it until the last. So, for him, it is normal that we only offer him the same if it is all we have. It is good in his eyes.

I need to go now. I am late.
....

ENVA d'Alfort, Day 8, Thursday

Resting

The surgical team at the Institute Montsouris, or IMM Recherche - CERA, has been able to move Baccarat's surgery up to Thursday. Five days sooner.

The studies undertaken here are large animal veterinary, as I understand it, but it is part of the Institut Mutualiste Montsouris, which is a human medical center in Paris. We are assured that they have state of the art technology and techniques, that the team operating on Baccarat operates on human beings in cardiovascular surgery, and that medically, we have the best possible care available.

This, I do not doubt. I knew that the moment we were referred to the Ecole National Vétérinaire d'Alfort.

This evening, after Dr. Gouni came to find Baccarat and I and give me the estimate for surgery, I was sitting at the edge of Baccarat's cage and listening to the older couple who had come to see the dog in the cage next to hers, a dog that lies there on its inflatable pad and twitches. She has neurological problems, among other things, they told me. Her chart said that she is sweet, but you must get her attention before touching her. Baccarat's chart said, under temperament, "Gentille", but today it read "Très gentille". Their dog had been operated on and was still recovering. They were older than I am. Well dressed. They bent into the cage, rather than sitting on the edge, as I did. She was worried. He seemed pragmatic, concerned, self-possessed. He exuded knowledge and confidence.

"Vous êtes médecin?" I asked. I already knew the answer.

"Oui," he nodded. Of course.

"En quoi?"

"Rhumatologie," he replied. I noted his suit without tie, shoes. The red thread at the lapel button hole indicating his membership in the Légion d'honneur. Something my husband, who wears jeans and long-sleeved cotton t-shirts to the hospital, to protect his arms from the polyester mix of the "blouse blanche", would refuse. I wondered how he had earned it, thinking he was probably a professor of medicine. I noted his well-coiffed, somewhat long gray hair and nodded.

"Mon mari aussi. Il est obstétricien-gynécologue." He nodded and looked from me to Baccarat.

"Elle va être opérée," said his wife, looking over from her dog. "Elle a une tumeur dans le coeur."

Her husband knew. I had told him while she talked to her dog. 18 years old, they had found her in a forest when she was 2, 16 years ago. I thought of Wisp, also found in the woods, and who is becoming mentally unstable since Baccarat has been hospitalized. This morning, walking up the stairs to clean Sam's room -- I know, don't tell me; I am hoping to install better habits before he gets his own place --, I smelled a smell. It was only when I got in the bathtub to take my shower before leaving for Maisons-Alfort that I noticed the smell again, particularly strong in the bathroom, and saw the pile of cat poop deposited in the corner between the tub and the window.

Damn it, said myself. Now what are we going to do?

"Clean it up and hope Baccarat makes it, because if she doesn't, we've got a serious problem developing."

"Elle a beaucoup de personalité," said the rhumatologist, "ça se voit dans ses yeux." His wife looked around again into Baccarat's cage.

"Elle est si belle," she said. "Elle a des yeux si communicatifs."

"C'est exactement ça," I said, nodding, and looking back at Baccarat.

It was only after they left and the student who has been caring for her since she arrived came and knelt next to me, after having asked with a big smile if I had been told, Baccarat would be operated on on Thursday, reaching in to caress her head, and said, before getting up to leave, "Vous pouvez rester le temps que vous voulez," that I broke down again. I stroked her head, while she lie there, resting, her eyes closed. She glanced at me. I reached for the scarf in my bag from the motorcycle and buried my face in it, wiping my tears.

The veterinarian on rotation in medical hospitalization came in. She had come to find me outdoors earlier and introduce herself, and now she stood there smiling at me. They hold us up, too. They encourage us, and they tell us to bring our families; we have to prepare ourselves, see our beloved animal before the surgery because, if it is very bad, it will be kinder not to wake her up only to suffer the pain of recovery for nothing.

I knew what she was going to say; my husband had anticipated it, and Dr. Gouni had said it. I said it before she had to. She smiled at me, and I looked at her eyelashes. The length of them. Their color. The spacing between them and their curve. Her eyes. I looked at her lips as she spoke and smiled. I wondered if I would be able to recognize her again, seeing all of her face at once. I could only see pieces of her. Could she tell how I was seeing her? I could hear her.

"Si," Dr. Gouni had said, "c'est très, très méchant, il serait peut-être mieux de ne pas --"

"La réveiller," I finished. "Je sais. Mon mari me l'a dit. Je fais confiance à l'équipe médicale et chirurgicale." She nodded.

If it is a not so very bad, but malignant, they will remove it, close and let her live out the time she has.

We know it is decided already. Prayers no longer serve any purpose. They never did. It is what it is, benign or malignant. Love and support are what we need. Caring eyes and compassion.

Hope will help until the phone rings sometime around 4 pm Thursday, but we are told that we must prepare ourselves. The new vet and I looked at Baccarat, and my eyes filled with tears again.

"On se demande seulement comment, comment cette chienne si pleine de vie et si jeune aurait pu avoir cette tumeur."

"Elle est déjà une chienne spéciale. Ca se voit dans ses yeux si expressifs. Elle va vers les gens. C'est clair qu'elle est bien avec les gens, et elle se bat. Elle ne se laisse pas aller, et cest très important," she said. She is right. Baccarat is fighting to stay with us. She is not giving up, lying down to let herself go.

"Je vais la laisser dormir, se reposer," I said.

"Oui, et nous allons bientôt faire ses soins du soir," she said, smiling again.

"Je serai là demain, et après demain, et mon fils aussi," I told her, "Mon mari est de garde à l'hôpital mercredi. C'est bête. Peut-être il va pouvoir me joindre demain soir." She nodded, and left me to say good-bye to Baccarat.

I had to stand and shut the glass door on her cage. She watched me, her eyes never leaving mine. I smiled. I wanted her to know that it was alright. That I believed it was alright.

"Je reviens demain, ma Bacs. Je t'aime."

I walked down the corridor, and on down the stairs, out to my motorcycle, waiting in the sun on the wide sidewalk along the avenue.
....